Provider Demographics
NPI:1699438754
Name:HOLY FAMILY LLC.
Entity type:Organization
Organization Name:HOLY FAMILY LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TINO
Authorized Official - Middle Name:RAJU
Authorized Official - Last Name:MANIMALETHU
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:586-578-9526
Mailing Address - Street 1:49650 LAKEBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-3511
Mailing Address - Country:US
Mailing Address - Phone:586-737-7144
Mailing Address - Fax:586-782-3847
Practice Address - Street 1:2850 PARENT AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-2472
Practice Address - Country:US
Practice Address - Phone:586-578-9526
Practice Address - Fax:586-782-3847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency